Abuse, Neglect and Exploitation Reporting Guide

Transcription

1 Abuse, Neglect and Exploitation Reporting Guide STATE FISCAL YEAR 2018 DIVISION OF HEALTH IMPROVEMENT 1

2 CONTENTS Definitions of abuse, neglect and exploitation 3 Abuse. 3 Neglect.. 3 Exploitation 3 Suspicious Injuries 3 Environmental Hazard 3 Recognizing abuse, neglect and exploitation/reportable incidents. 4 Reporting ANE, suspicious injuries, environmental hazards and death 8 Ensuring safety may include the following 8 Reporting means 8 Internal Investigations Prohibited. 9 SFY 2016 ANE Report Form; Correctly completed sample. 9 Notification requirements for community based service providers. 14 DDSD General Events Reporting (GER) 15 Abuse, neglect and exploitation reporting flow chart. 17 Immediate Action & Safety Plan 18 How to create an Immediate Action & Safety Plan.. 18 How to respond to sexual assaults.. 24 State-wide SANE programs. 25 Regulatory Highlights.. 29 NMAC Caregivers Criminal History Screening Requirements 29 NMAC Employee Abuse Registry (EAR) 30 NMAC Incident Reporting, Intake, Processing and Training Requirements 32 ANE Train-the-Trainer Course.. 34 Retaliation Prohibited. 34 DHI/: Who are we and what do we do? Mission 35 2

3 What happens during a DHI/ investigation?.. 35 Priority Levels for Assigned Investigations.. 36 What happens during a DHI/ Investigation 37 Review of the Immediate Action and Safety Plan. 38 The investigation process: How are the facts obtained? Audio Recording Interviews.. 39 Weighing the Evidence.. 39 The Investigative Conclusion. 39 Investigation Time Frames. 40 Investigation Findings.. 40 Notification of Findings 40 Referrals Made by 47 Requesting Reconsideration of the Investigative Findings.. 47 Polices that guide DHI/ investigations. 48 Contact Information. 49 DEFINITIONS OF ABUSE, NEGLECT, AND EXPLOITATION ABUSE is defined as: (1) knowingly, intentionally, and without justifiable cause inflicting physical pain, injury or mental anguish; (2) the intentional deprivation by a caretaker or other person of services necessary to maintain the mental and physical health of a person; or (3) sexual abuse, including criminal sexual contact, incest and criminal sexual penetration. SEXUAL ABUSE is defined as the inappropriate touching of a recipient of care or services for sexual purpose or in a sexual manner, and includes kissing, touching the genitals, buttocks, or breasts, causing the recipient of care or services to touch another for sexual purpose, or promoting or observing for sexual purpose any activity or performance involving play, photography, filming, or depiction of acts considered pornographic. Sexual conduct engaged in by an employee with a person for whom they are providing care or services is sexual abuse per se. VERBAL ABUSE is defined as profane, threatening, derogatory, or demeaning language, spoken or conveyed with the intent to cause mental anguish. 3

4 MENTAL ANGUISH is defined as a relatively high degree of mental pain and distress that is more than mere disappointment, anger, resentment, or embarrassment, although it may include all of these, and is objectively manifested by the recipient of care or services by significant behavioral or emotional changes or physical symptoms. NEGLECT is defined as the failure of the caretaker to provide basic needs of a person, such as clothing, food, shelter, supervision, and care for the physical and mental health of that person. Neglect causes, or is likely to cause harm to a person. EXPLOITATION is defined as an unjust or improper use of a person's money or property for another person's profit or advantage, financial, or otherwise. SUSPICIOUS INJURIES: Not defined in NMAC. Please see examples on pages 6 & 7. ENVIRONMENTAL HAZARD: A condition in the physical environment which creates an immediate threat to health and safety of the individual. PERSON OF TRUST - A trust relationship is defined as caregivers or others involved in the life of the individual who bear or have assumed some responsibility for protecting the interests of the person, or where expectations of care or protection arise by law or social convention and includes family members and others who are aware of the person s vulnerability and exploit it. It excludes perpetrators who are strangers. LIKELY RISK OF HARM - Risk of harm refers to clinically significant harm which has not yet occurred but is likely to occur, given risk factors identified in the present. The level of future risk is identified as likely (probable), not just possible (may occur). The probable harm will have a significant detrimental effect on the consumer if it does occur. RECOGNIZING ABUSE, NEGLECT, EXPLOITATION, ENVIRONMENTAL HAZARDS AND SUSPICIOUS INJURIES Physical Abuse Examples: Infliction of injury: bruising, lacerations, welts, burns, fractures or dislocations Hitting, slapping, biting, shaking or kicking Pulling arms, hair or ears Bending back fingers or bending an arm up behind the back Placing hot substances or non-food items in the mouth for swearing Physically restraining a consumer without approved reason or doing so without training/certification Actions that result in bodily harm Use of medication as a chemical restraint Depriving a person of services such as medical, therapeutic, or behavioral services that they need to remain healthy. Verbal Abuse Examples: Intimidating gestures (such as shaking a fist, aggressive posturing, and others) Use of racial slurs Criticizing 4

5 Name calling Yelling or screaming Using ridicule or demeaning language Using threats Sexual Abuse Examples: Engaging in any sexual contact Exposure to pornographic materials Making sexual advances Harassment of a sexual nature that demeans, humiliates or embarrasses Inappropriate touching Sexual innuendo Possible Signs of Abuse: Typical response by the consumer changes without explanation The consumer exhibits unusual fear or anxiety The consumer has sudden unexplained changes in their behavior The consumer is injured or bleeding from around their genitals The consumer flinches/cowers in presence of caregiver or other trusted person Injuries sustained by the consumer that cannot be explained, or the explanation does not match the injury Signs of pain experienced by the consumer are unexplained There are unexplained changes in the consumer s sleeping patterns, appetite, or actions The consumer has an increased need to seek approval or comfort The consumer does not seem to be him or herself and there is no apparent cause for the change Neglect Examples: Not supervising a person as required to keep them safe Spends long periods of time in own feces or urine Has untreated medical conditions The provider has assigned insufficient staff to meet the needs of the consumers they support Failing to follow-up on health/medical symptoms Has unhealed sores or untreated injuries Medication is administered by untrained staff G-tube protocols are not followed as prescribed Failing to follow a positive behavior support plan or crisis plan Unsafe living conditions (could also be Environmental Hazard) Providers not training their staff to support consumer s plans Leaving someone in a hot car, unattended Failing to seek medical attention in a timely manner Failing to follow expected procedures outlined in emergency response plans, health care plans, therapy plans, mealtime plans, etc. Medication error that results in the need for medical treatment or the agency nurse determines the need to consult with a physician/cnp/pa, pharmacist or poison control regarding potential need for medical intervention (does not include mere notification). The individual misses multiple doses of medication over a period equal to or greater than 48 hours, or misses a single dose that places the consumer at a risk of harm. A prescribed medication is delivered to the wrong person Possible Signs of Neglect: 5

6 The consumer has a foul odor of urine or feces The consumer is malnourished or dehydrated The consumer has experienced significant weight loss without dieting or medical reasons The consumer is not dressed appropriate for weather conditions The consumer has poor dental hygiene The consumer has illness or injuries that are not being treated The consumer is left alone when they are supposed to be supervised The consumer has frequent constipation episodes The consumer has frequent trips to the emergency room The consumer s food, medication or personal care is withheld The consumer exhibits a failure to thrive (not linked to diagnosis) The consumer has multiple small bruises The consumer s adaptive equipment is not individualized or in working condition. There are unexplained changes in the consumer's sleeping patterns and appetite Examples of Exploitation: Use of the consumer s funds to meet caregiver s needs Taking consumer s paycheck or social security funds Taking consumer s clothing or other belongings Unauthorized withdrawal of funds Borrowing consumer s possessions, for example, DVDs, lawn mowers and others Staff s use of consumer s transportation for their own purposes Staff use of the consumer s telephone, leaving the consumer to pay the cost of the calls Forcing to sell or give away property or possessions Staff s use of the consumer s food stamps to purchase food for themself Borrowing money, even if offered by the consumer and/or reimbursed to the consumer Providers charging business expenses to the consumer Possible Signs of Exploitation: The consumer is regularly denied outings and activities due to a lack of funds The consumer has insufficient money to meet normal budgetary expenses The consumer pays fees or charges imposed for late payments The consumer is denied housing subsidies or food stamps through no fault of their own The consumer s cost of living expenses are not fairly divided between house mates The consumer s money is not accounted for The consumer s personal funds accounting records indicate unusual or inappropriate purchases The consumer s personal fund are used to pay for household items they do not use such as a tropical fish tank or internet service The consumer does not have access to personal funds The consumer s money, household goods or personal property (television, ipad, computer, clothing, etc.) disappear The consumer s personal funds are not adequately overseen The consumer loses approved supplemental income or assistance The consumer s funds are used to supplement another consumer s needs Examples of Environmental Hazards: Bed bugs are found in the person s home The consumer s residence has mold growing on the bathroom walls The consumer s home is infested by insects There is a gas leak at the day habilitation site 6

7 Broken windows have not been repaired Air conditioning or heat is not functioning Toilet is not functional Possible Signs of Environmental Hazards: The consumer has numerous insect bites on their body The consumer is experiencing otherwise unexplained respiratory symptoms The consumer s residence is in ill-repair Observing a large number of rodents around the residence Lack of potable water or no electricity Examples of Suspicious Injuries: A patterned bruise, no matter its size, that is in the shape of an identifiable object such as a belt buckle, shoe, hanger, etc. Unexplained serious injuries or multiple bruises, cuts, abrasions A spiral fracture Dislocated joints (e.g. shoulders, fingers) Facial or head injuries (e.g. black eyes, injuries to the scalp) Bruising to an area of the body which does not typically or easily bruise (e.g. midline stomach, breasts, genitals or middle of the back) Injuries that are not consistent with what is reported to have happened, for example: o bruising to the inner thighs are explained to have been sustained in a fall that happened in the driveway o injuries explained as caused by self-injury to parts of the body the consumer has not previously injured or cannot access o Injuries are explained as having been caused by another consumer but the consumer has no history of such behavior or there is no documentation of an incident A pattern of injuries such as injuries recurring during certain shifts or at certain times of the day The explanation for how an injury occurred is not reasonable, probable, or is unlikely Internal injuries Petechiae (definition: pinpoint round spots appearing on the skin as the result of bleeding under the skin or the result of minor hemorrhages caused by physical trauma) The consumer is repeatedly injured when certain staff is working, even when there is an explanation of how the injury occurred 7

8 REPORTING ABUSE, NEGLECT, EXPLOITATION, SUSPICIOUS INJURIES, ENVIRONMENTAL HAZARDS, AND DEATH Your first and foremost responsibility is to ensure the safety of consumer(s). If you witness or learn of an allegation or incident of abuse, neglect, exploitation, suspicious injury, environmental hazard or death you must report it immediately. Ensure safety first in the event action is required to prevent harm, such as obtaining emergency medical treatment. Your second duty is to report abuse, neglect, exploitation, suspicious injuries, environmental hazard, and death to the DHI/ ANE Hotline. Examples: ENSURING SAFETY MAY INCLUDE THE FOLLOWING seeking medical attention when someone has injuries or other medical needs; contacting law enforcement if you have reason to believe a crime was committed; providing first aid; protecting consumers from hazards in their environment; making sure that accused individuals do not have contact with the consumer(s). REPORTING MEANS Immediately notifying DHI/ that an incident of abuse, neglect, exploitation, suspicious injury, environmental hazard or death has occurred. There is a 24-HOUR ANE REPORTING HOTLINE to receive and process reports of abuse, neglect, exploitation, suspicious injury, environmental hazard and death: As soon as you have ensured that immediate safety needs are addressed, you are required by NM Administrative Code NMAC to call the ANE Hotline. Make sure that you are prepared to tell DHI/ what happened: o Who is the alleged victim(s)? o Where did the incident happen? o Is someone named or identified as responsible for the abuse/neglect/exploitation, environmental hazard or suspicious injury? o What did you do, or what do you plan to do, to ensure that consumer(s) are safe, given the incident/allegation? Make sure that you complete a SFY 2018 DHI/ANE Incident Report: o The person with the most firsthand knowledge about what happened should participate in the preparation of the form; o Each of the fields should be filled in; and o The ANE Incident Report should be provided to DHI/ within 24 hours of the incident (via the Internet or by fax) 8

9 INTERNAL INVESTIGATIONS PROHIBITED When an ANE incident occurs, the Agency often wants to conduct their own investigation to find out what happened. However, conducting internal investigations while an investigation is pending can seriously jeopardize the integrity of the investigation and are strictly prohibited. NMAC (C)(3) states, No investigation beyond that necessary in order to be able to report the abuse, neglect or exploitation and ensure the safety of the consumers is permitted until the division has completed its investigation. SFY 2018 ANE REPORT FORM: CORRECTLY COMPLETED SAMPLE The following seven images illustrate a sample of a correctly and thoroughly completed ANE Report Form. Please note: All sections of the ANE Report Form must be completed. Blank areas may result in problems submitting the on-line form. It is important for to receive a thoroughly and accurately completed ANE form. A thoroughly completed ANE Report Form assists in the screening of the incident/allegation, reduces the need for follow-up contacts and questions, is used as evidence for the investigation, provides information about incidents reported to, and to identify patterns and trends to assure adequate protections from harm. 9

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14 NOTIFICATION RQUIREMENTS FOR COMMUNITY BASED SERVICE PROVIDER AGENCIES Responsible providers must notify the individual s case manager or consultant within 24 hours that an alleged incident involving ANE has been reported. Responsible providers shall ensure that the legal guardians or parents (if individual is a minor) is notified of the alleged incident of ANE within 24 hours of the alleged incident unless the parents or legal guardian is suspected of committing the alleged abuse, neglect or exploitation. Non-responsible reporters: Providers who are reporting an incident in which they are not the responsible community-based service provider shall notify the responsible communitybased service provider within 24 hours of an incident or allegation of abuse, neglect, and exploitation. 14

15 DDSD GENERAL EVENTS REPORTING (GER) Effective July 1, 2014, NMAC changed the requirement of the reporting of all emergency service and law enforcement incidents. These incidents involve a DOH funded consumer, but do not involve an event defined as abuse, neglect or exploitation, suspicious injury, death, or environmental hazard. Reported issues or complaints that do not meet any of the definitions of Reportable Incidents (ANE, suspicious injury, environmental hazard, death, or ORI), may need to be reported to other entities that have jurisdiction and can take appropriate action. The following events should be reported to the Developmental Disabilities Supports Division (DDSD) through General Events Reports (GER) in Therap.** A Consumer s utilization of emergency services A Consumer's hospitalization or psychiatric facility admission Law enforcement intervention that results in the arrest or detention of a consumer ** Please note: If any factors that contributed to the use of emergency service, hospitalization, or law enforcement may have been the result of abuse, neglect, exploitation, environmental hazards, or involve suspicious injuries, it is the expectation that they be reported to DHI/ immediately. Examples include: A consumer is transported to the hospital by ambulance after choking during dinner. Her mealtime plan requires her food to be cut into ¼ sized bites. The person who prepared and served her meal was not trained in her mealtime guidelines and served her a whole hotdog for dinner. Law enforcement is called following an incident where the consumer assaulted his staff. Prior to the assault, the staff person was making fun of the consumer for soiling their pants during a community outing. A consumer is transported to the emergency room where he is diagnosed with an abdominal contusion. His staff said that he fell out of bed during the night. The consumer experienced a series of seizures that are more severe and more frequent than commonly exhibited. 911 was called and the person transported to the emergency room by ambulance. It is found that she has not been administered her seizure medication in two weeks. Other incidents may require reporting to entities other than DHI/ and DDSD (GER). These include Adult Protective Services, Child Protective Services, and Law Enforcement Agencies. Examples include: 15

16 o o o During a visit to a supported living provider, the consumer s minor sister tells staff that her mother s boyfriend inflicted the injury noticed to the child s left eye. This would be reportable to Child Protective Services. During a visit to a Family Living Provider, you notice that the consumer s live-in grandmother is lying on a soiled mattress on the floor and you later hear faint cries for help from the bedroom where she is located. This would be reportable to Adult Protective Services. While conducting a visit to the home of a Mi Via consumer, you see the consumer s step-father trade money for illegal drugs in the drive-way. He tells you that it helps to keep the consumer calm. This incident would be reportable to both DHI/ and Law Enforcement. Child Protective Services Reporting Hotline: SAFE (7233) or #SAFE from a cell phone Adult Protective Services Reporting Hotline: Health Facility Program and District Operations Bureaus (formerly Health Facility Licensing and Certification) Includes: Nursing Homes, Assisted Living Homes, Intermediate Care Facilities, Hospitals, Federally Qualified Health Care Clinics and Home Health Agencies. Call the Health Facility Complaints Hotline New Mexico Board of Nursing The Director of Compliance Tani Skinner; please contact her directly at (505) if you have any questions. Complaints may be submitted to the NM Board of Nursing in writing, by fax, , or in person. New Mexico Human Services Division Office of Inspector General HSDOIGFraud@state.nm.us 16

17 ABUSE, NEGLECT, EXPLOITATION REPORTING FLOW CHART Determine if incident requires an ANE report or a General Events reports If ANE IF GER Report GER in Therap or other Data When the Reporter is the Responsible Provider, it is the Responsibility of the Reporter to: When the Reporter is NOT the Responsible Provider, it is the Responsibility of the Reporter to: Reporter/Responsible Provider ensures the Safety of the Consumer by: Taking direct action or reporting as needed Immediately reporting to law enforcement or calling for emergency medical services as appropriate to ensure the safety of Reporter ensures the Safety of the Consumer by: Taking direct action or reporting as needed Immediately reporting to law enforcement or calling for emergency medical services as appropriate to ensure the safety of consumers Reporter/Responsible Calls DHI at and reports the alleged Abuse, Neglect, or Exploitation Reporter Calls DHI at and reports the alleged Abuse, Neglect, or Exploitation Responsible Provider works with DHI to ensure the safety of the consumer revising the Immediate Action and Safety Plan as needed Responsible Provider completes an Immediate Action & Safety Plan and submits to DHI within 24-hours. Reporter notifies the Responsible Provider Responsible Provider works with DHI to ensure the safety of the consumer revising the Immediate Action & Safety Plan as needed Reporter completes an ANE report and submits to DHI within 24-hours, if requested by intake Responsible 17 Provider complete an Immediate Action & Safety Plan and submits to DHI within 24-hours.

18 IMMEDIATE ACTION AND SAFETY PLAN One of the revisions to NMAC includes the responsibility of Community-Based Service Providers to develop a plan to keep people safe and implement the plan when an incident or allegation of abuse, neglect, exploitation, environmental hazard or suspicious injury is reported. It is called an IMMEDIATE ACTION AND SAFETY PLAN. The IMMEDIATE ACTION AND SAFETY PLAN outlines what happened and to whom, identifies who could be at risk because of what happened or was alleged to have happened, the provider s plan to keep people safe while the DHI/ investigation takes place, and identifies who is responsible for making sure that the plan is followed and revised as needed. If a death was unexpected or occurred under unusual circumstances, DHI/ will screen and may investigate the incident. If determines an investigation is warranted, the Provider must submit an IMMEDIATE ACTION AND SAFETY PLAN. DHI/ developed a form for Providers to use to record their IMMEDIATE ACTION AND SAFETY PLANNING activities. The IMMEDIATE ACTION AND SAFETY PLAN form can be found on the DHI Website. For Providers who have Internet access, the form must be submitted via the DHI website or Providers without Internet access, the form may be faxed to DHI at HOW TO CREATE A THOROUGH IMMEDIATE ACTION AND SAFETY PLAN When developing an IMMEDIATE ACTION AND SAFETY PLAN, there are four (4) things that should immediately happen: 1. Identify who is at risk given the nature of the allegation or reported incident; and 2. Determine how to protect anyone who could be impacted by what was alleged or reported to have happened; and 3. Be prepared to verbally report what steps will be taken to keep the consumer(s) safe at the time you report the incident to DHI/. 4. Make revisions to the initial IMMEDIATE ACTION AND SAFETY PLAN as directed by DHI/. 18

19 DETERMINING WHO IS AT RISK: IF IT WAS TRUE, WHAT SHOULD I DO? In many cases, the identification of who is at risk given what was alleged or reported to have happened is a straightforward task. Consider the following incident: Sally reported that her third shift staff, Joe, yells at her and pushes her when she gets out of bed at night. Sally is easily identified as a consumer at risk. Identify others that may be at risk given what was alleged: Does Sally live with anyone else? If so, her housemates could be at risk. Does Joe work in homes other than Sally s? If so, the residents of the other homes could be at risk. Does Joe perform other tasks for the provider? Does he drive a van that transports consumers to and from day activities? If so, others could be identified as being at risk. Does Joe work for a provider other than Sally s? If so, consumers of other Provider agencies could be at risk. HOW DO I PROTECT THOSE IDENTIFIED AT RISK? After identifying anyone who could be at risk given the nature of what was reported/alleged, it is necessary to determine how the risk will be minimized to keep everyone safe who could be impacted. Keeping in mind the allegation/incident above, and in particular the physical abuse allegation, a plan to keep consumers safe could include the following: Re-assigning Joe to work in the office, or a position that will not place him in direct contact with consumers. Placing Joe on administrative leave pending the outcome of the DHI/ Investigation. RE-CAP: IMMEDIATE ACTION AND SAFETY PLAN REQUIREMENTS First and foremost, always ensure the safety of the consumer(s), including separating the alleged victim(s) from an accused person, providing needed first aid, or obtaining medical care. Immediately report the allegation of Abuse, Neglect, Exploitation, Suspicious Injury, Environmental Hazard or Death by calling the Division of Health Improvements (DHI) hotline number at Develop, implement and verbally report the initial IMMEDIATE ACTION AND SAFETY PLAN to DHI hotline. 19

20 Within 24-hours of contacting the DHI hotline, complete and submit an IMMEDIATE ACTION AND SAFETY PLAN form online at Providers without Internet access may submit the completed form via fax at The following includes a scenario and an example of what might be included in an Immediate Action and Safety Plan. Scenario: It was reported to on 6/1/15 by Jim S. (a staff from ABC Provider Agency) that a co-worker, Charlie F., was seen squeezing Eric M. s (a consumer receiving services from ABC provider) arm and yelling at him in a very angry manner. The incident took place on 6/1/15 at about 3:15pm. Jim had walked around the corner into the kitchen and noticed Charlie F. squeezing Eric s arm and angrily speaking to him. Jim immediately confronted Charlie about what he had observed. EXAMPLE: IMMEDIATE ACTION & SAFETY PLAN Responsible Provider: Sunshine Community Alleged Victim(s) include birth date or social security number): Eric Mitt. DOB Accused Person(s): Charlie Frank. Relationship to Alleged victim(s): Direct Care Staff Date of Incident: 6/1/17 Time of incident: Approximately 3:15pm Did the incident create concern for the safety of consumer(s) served? Yes No Immediate Action and Safety Plan drafted by (Name and title): Jim Stevens, Incident Coordinator 20

21 Section 1. - Required Section 2. - Required Section 3. - Required Describe the identified Safety Risk(s) When describing the safety risk, be sure to name the consumer(s). Action to address risk What action has or will be taken to protect the consumer(s) from the identified safety risks(s)? Plan Management How will the plan be managed? Who is responsible for implementing the plan? Who is responsible for communicating the plan? On 6/1/17 it was reported that Charlie F. was squeezing Eric M s arm and speaking to him in an angry way. Risk of injury and/or verbal abuse. The co-worker, Jim S., who witnessed the incident confronted Charlie F. about the incident. Charlie F. indicated that the alleged incident did not occur and that Jim S was mistaken. Jim contacted his supervisor and then called. According to Jim his supervisor came to the home and spoke with Charlie. Charlie indicated that the incident did not occur, however the supervisor did send Charlie home and indicated that he would contact him the next day. Charlie F. has been removed from duty pending investigation. Sally Smith, Incident Coordinator, is responsible for ensuring the plan is implemented and communicated. Signatures and Dates for Immediate Action and Safety Plan To the best of my knowledge the attached Immediate Action and Safety Plan has been implemented as described and all those who are responsible for carrying out the plan have been alerted to the Immediate Action and Safety Plan and have agreed implement. Author of Plan (Name and title): Jim Stevens, Incident Management Coordinator Number: Phone Signature: Jim Stevens Date: 6/1/17 21

22 SEXUAL ASSAULT How to Respond to Sexual Assault 1. Ensure victim is safe; call law enforcement and the Sexual Assault Nurse Examiner s (SANE) Unit at...(see the list of Sexual Assault Nurse Examiner beginning in page 25). 2. Obtain emergency medical attention, including testing for pregnancy and treatment for sexually transmitted diseases. This is usually done in the local hospital Emergency Department. Staff should never remove any object placed in any orifice unless it presents an immediate threat. 3. Have SANE exam completed, which will utilize an evidence kit. Most SANE programs will not do an examination unless requested by a law enforcement agency. Work with law enforcement to get the SANE examination scheduled. 4. Do not allow the consumer (victim) to bathe, shower or otherwise clean up (i.e. brush teeth, urinate, alter physical self, engage in other activity that may contaminate or destroy valuable evidence such as semen, saliva, hairs, etc.). 5. Ensure that clothing worn during and immediately after the assault is collected and taken to the SANE unit. 6. Evidence may still be present up to 72-hours after the event. If the Individual has not bathed or changed clothes, the 72-hours may be extended. Physical trauma may be present after the 72-hour time frame. 7. Evidence collection can be a time-consuming process. Be prepared for waits of 2-8 hours. 22

23 NEW MEXICO SANE PROGRAMS Alamogordo Southern NM Wellness Alliance Staci Guerrero MAIL: PO Box 2626 Alamogordo, NM Otero County phone SANE dispatch or Albuquerque Statewide SANE Coordinator Connie Monahan PHYSICAL: 3909 Juan Tabo Blvd. NE, Suite 6 Albuquerque, NM All counties phone fax conniem@swcp.com Albuquerque SANE Collaborative Teresa D Anza or Gail Starr MAIL: PO Box Albuquerque NM PHYSICAL: 625 Silver SW Suite 2206 Albuquerque, NM Bernalillo County phone fax SANE dispatch teresa.danza@abqsane.org or gail.starr@abqsane.org

24 Para Los Niños Program Dr. Shalon Nienow, Medical Director PHYSICAL: 625 Silver Ave SW Albuquerque, NM Bernalillo County Child Sexual Abuse - emergency and scheduled evaluations phone fax Ask for pediatric triage snienow@salud.unm.edu Website» Crownpoint Crownpoint Healthcare Facility Stacy Jervis MAIL: PO Box 358 Crownpoint, NM PHYSICAL: June Hwy 371 Rt 9 Crownpoint, NM McKinley County phone SANE dispatch stacy.jervis@ihs.gov Farmington Sexual Assault Services of Northwest NM Eleana Butler or Dixie Roberts PHYSICAL: 622 West Maple Suite H Farmington, NM San Juan County phone fax SANE dispatch emergency eleanab@sasnwnm.org or dixier@sasnwnm.org

25 Gallup Gallup Indian Medical Center Debra Hicks PHYSICAL: 516 E Nizhoni Blvd Gallup, NM McKinley County Adults and Adolescents phone SANE dispatch debra.hicks@ihs.gov Las Cruces Las Cruces La Piñon SANE Project Stacey Blazer-Clark MAIL: La Piñon SANE Project 525 S. Melendres Las Cruces, NM PHYSICAL: Memorial Medical Center 2450 South Telshor Las Cruces, NM Doña Ana County SANE office La Piñon office SANE dispatch stacey@lapinon.org Portales Arise Sexual Assault Services Leigh Ana Eugene or Tawnya Burton or Gretchen Koether MAIL: Roosevelt General Hospital PO Drawer 868 Portales, NM Roosevelt County phone fax SANE dispatch leigh@arisenm.org or tawnya@arisenm.org or gretchen@arisenm.org

26 Roswell I Can Survive Roswell Refuge SANE Project Kim Hansen MAIL: Roswell Refuge 1215 N. Garden Roswell, NM Chaves County phone fax babynurse_88201@hotmail.com Santa Fe Christus St. Vincent Regional Medical Center SANE Program Colleen Dearmin MAIL: 455 St. Michael Drive Santa Fe, NM PHYSICAL: 6601 Valentine Way Santa Fe, NM Santa Fe County phone fax SANE dispatch colleen.dearmin@stvin.org Silver City Silver Regional Sexual Assault Support Services and SANE Julia Talavera MAIL: 301 W College Ave Suite 6 PHYSICAL: La Clinica 3201 N Ridge Loop Drive Silver City, NM Grant County phone fax emergency sassexecutivedirector@gmail.com Website»

27 Taos Taos/Holy Cross Hospital SANE Program Patty Hannigan PHYSICAL: 1329 Gusdorf Road Taos, NM phone SANE dispatch REGULTORY HIGHLIGHTS NMAC RULE APPLIES TO THE FOLLOWING PERSONS, ORGANIZATIONS OR LEGAL ENTITIES: Community Programs that provide services under: o o o Developmental Disabilities Waiver (DDW) Medically Fragile Waiver Mi Via Self-Directed Waiver NMAC CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS Requires all applicants, caregivers (including hospital caregivers) to consent to a nationwide and statewide criminal history screening (via fingerprint card) no later than 20 calendar days from the first day of employment or contractual relationship. Requires all new employees not have contact with any individuals served by provider agency pending written notice of completion (with either clearance of the caregiver or notice of a disqualifying conviction) of criminal background check. Individuals with disqualifying felony convictions are barred from employment or contractual services as a caregiver

28 NMAC EMPLOYEE ABUSE REGISTRY (EAR) This registry originally took effect on January 1, It is an electronic registry of persons with substantiated registry referred complaints of abuse, neglect or exploitation that meet severity standards. It supplements other pre-employment screening requirements such as Caregiver Criminal History Screening (CCHS). This regulation applies to all health care providers, employees, and contractors of those providers. It does not apply to NM licensed health care professionals practicing within the scope of a license or a CNA. (If these individuals are substantiated for ANE they will be referred to their licensing or certification board. It requires that employers check the registry prior to employing or contracting with someone. A provider may not employ or contract with a person listed on the registry. DHI/ uses the EAR rules to evaluate cases of substantiated ANE of an accused person. If they believe the NMAC criteria are met, DHI/ makes a referral to the registry. The accused person who was substantiated for ANE will be notified that they have been referred to the EAR by receiving a DOH letter. Persons referred to the registry may request a hearing in writing within thirty (30) calendar days. If no hearing request in writing is received after the thirty (30) calendar days the person is placed on the registry and, if employed, must be terminated immediately. EAR definitions of Abuse, Neglect and Exploitation differ from definitions in NMAC Incident Reporting that were described earlier on page 3. The EAR includes severity standards that assess the impact of the ANE on the recipient of services and that assess the employee (who has been substantiated for ANE) for aggravating factors. EAR abuse definition: (1) Knowingly, intentionally or negligently and without justifiable cause inflicting physical pain, injury or mental anguish, and includes sexual abuse and verbal abuse; or (2) The intentional deprivation by a caretaker or other person of services necessary to maintain the mental and physical health of a person. EAR severity standard for abuse: A substantiated complaint of abuse meets the severity standard if: (1) Abuse results in, or is a contributing factor to, death; (2) Abuse results in the infliction of a significant, identifiable physical injury that reasonably requires or results in medical or behavioral intervention or treatment; (3) Abuse results in any injury for which criminal charges are brought against the employee resulting in a plea or conviction;

29 (4) Abuse results in the infliction of excruciating pain or pain that endures over a significant timeperiod; (5) Abuse causes significant mental anguish as evidenced by the victim s descriptions, or significant behavioral changes; (6) Abuse is sexual abuse; or (7) Abuse is verbal abuse that causes significant mental anguish, including psychological or emotional damage, and which is evidenced by significant behavioral changes or physical symptoms. EAR neglect definition: Subject to a person s right to refuse treatment and subject to a provider s right to exercise sound medical discretion, the failure of an employee to provide basic needs such as clothing, food, shelter, supervision, protection and care for the physical and mental health of a person or failure by a person that may cause physical or psychological harm. Neglect includes the knowing and intentional failure of an employee to reasonably protect a recipient of care or services from nonconsensual, inappropriate or harmful sexual contact including such contact with another recipient of care or services. EAR severity standard for neglect: A substantiated complaint of neglect meets the severity standard if: (1) Neglect results in, or is a contributing factor to, death; (2) Neglect results in the infliction of a significant, identifiable physical injury that reasonably requires or results in medical or behavioral intervention or treatment; (3) Neglect results in any injury for which criminal charges are brought against the employee resulting in a plea or conviction; (4) Neglect results in the infliction of excruciating pain or pain that endures over a significant time period; or, (5) Neglect causes significant mental anguish as evidenced by the victim s descriptions, or significant behavioral changes. EAR Exploitation Definition An unjust or improper use of a person s money or property for another person s profit or advantage, pecuniary or otherwise

30 EAR severity standard for exploitation: A substantiated complaint of exploitation meets the severity standard where unjust or improper use of the money or property belonging to the recipient of care or services results in: (1) A single instance of an objectively quantifiable loss, the value of which exceeds the lesser of either: (a) twenty five dollars ($25); or, (b) twenty five percent (25%) of the monthly income available to the recipient of care or services for purchasing personal items or discretionary spending; or (2) A subjectively substantial loss to the recipient of care or services due to a special attachment to the property, as demonstrated by anger, fear, frustration, depression or behavioral changes caused by the loss. EAR Aggravating factors: A substantiated complaint of abuse, neglect or exploitation meets the severity standard requiring referral of the employee for placement on the registry where: (1) The employee used alcohol or a controlled substance at or near the time of the substantiated abuse, neglect or exploitation; or (2) The employee used, brandished or threatened to use, a weapon in connection with the substantiated abuse, neglect or exploitation. [ NMAC N, 01/01/2006] NMAC INCIDENT REPORTING, INTAKE, PROCESSING AND TRAINING REQUIREMENTS OVERVIEW The Department of Health (DOH) offers free training in the recognition and reporting of Abuse, Neglect, and Exploitation and ANE Train-the-Trainer opportunities. You can request this training by ing: ANE.Training@state.nm.us 1. Community based providers must immediately report abuse, neglect, exploitation, suspicious injury, environmental hazards and death to the DHI hotline ( ), and then complete an ANE Report Form submitting it to DHI within 24 hours of the incident. 2. Limited provider investigation: No investigation beyond that necessary in order to be able to accurately report the abuse, neglect, or exploitation and ensure the safety of consumers is permitted until the division (DHI/) has completed its investigation

31 Note: It may be necessary for the provider to take actions short of conducting an investigation after they have received a report or allegation of ANE. First and foremost is provision of medical treatment and ensuring safety as described in the IMMEDIATE ACTION AND SAFETY PLAN section. They may need to obtain clarity from a reporter when receiving a general report of abusive conditions. They may need to obtain clarity from a reporter who documented observing abuse. The provider may need additional detail to identify the accused staff. Most of the permissible actions are related to identification of risk to consumers and assurance of safety pending an investigation. 3. IMMEDIATE ACTION AND SAFETY PLANNING: Upon discovery of any alleged incident of abuse, neglect or exploitation, the community-based service provider shall: a. Develop and implement an IMMEDIATE ACTION AND SAFETY PLAN for any potentially endangered consumers, if applicable; b. Be immediately prepared to report that IMMEDIATE ACTION AND SAFETY PLAN verbally, and revise the plan according to the division s direction, if necessary; and c. Provide the DHI accepted IMMEDIATE ACTION AND SAFETY PLAN in writing within 24 hours of the verbal report. If the provider has internet access, the report form shall be submitted via the division s website at otherwise it may be submitted by faxing it to the division at Evidence preservation: The community-based service provider shall preserve evidence related to an alleged incident of abuse, neglect or exploitation, including records, and do nothing to disturb the evidence in cases in which an investigator will be on site within 24 hours. If physical evidence must be removed or affected, the provider shall take photographs or do whatever is reasonable to document the location and type of evidence found which appears related to the incident. 5. Legal guardian or parental notification by reporter: The community-based service provider shall ensure that the consumer s legal guardian or parent (if a minor) is notified of the alleged incident of abuse, neglect and exploitation within 24-hours of notice of the alleged incident unless the parent or legal guardian is suspected of committing the alleged abuse, neglect or exploitation, in which case the community-based service provider shall leave notification to the division s investigative representative. 6. Case manager or consultant notification by community-based service providers: Community-based service providers shall notify the consumer s case manager or consultant within 24 hours that an alleged incident involving abuse, neglect, or exploitation has been reported to the division. Names of other consumers and employees may be redacted before any documentation is forwarded to a case manager. 7. Non-responsible reporter: Providers who are reporting an incident in which they are not the responsible community-based service provider shall notify the responsible communitybased service provider within 24 hours of an incident or allegation of an incident of abuse, neglect, and exploitation

32 8. Incident policies: All community-based service providers shall maintain policies and procedures which describe the community-based service provider s immediate response, including development of an IMMEDIATE ACTION AND SAFETY PLAN acceptable to the division where appropriate, to all allegations of incidents involving abuse, neglect, or exploitation, or suspicious injury as required in Paragraphs (2) of Subsection A of NMAC ANE TRAIN-THE-TRAINER COURSE In 2016, DOH began certifying community-based provider trainers to teach ANE reporting in a faceto-face adult learning environment. Direct care staff are already required to have ANE reporting training annually. This project will give us an opportunity to ensure the material is being taught in accordance with the curriculum and consistently throughout the state. The DDSD will provide a Train-the-Trainer curriculum to community-based providers in order for providers to train their own staff. The curriculum includes the Train-the-Trainer training, and an instructors guide for use by the instructor. A training DVD is provided Online. The training includes each student performing a one-hour teach back to the Instructor, in order to demonstrate competency to teach the material. Each ANE Trainer will be certified by DDSD. ANE training using DDSD s materials will only be accepted if taught by a certified ANE trainer. RETALIATION PROHIBITED often hears reports from direct care staff that the community-based provider retaliated against them for making an ANE report. While we understand not all of these reports are accurate, retaliation against anyone making an ANE report is strictly prohibited. NMAC (E) states, Any person, including to but not limited to an employee, volunteer, consultant, contractor, consumer, family members, guardian and another provider who, without false intent reports an incident or makes an allegation of abuse, neglect or exploitation shall be free of any form of retaliation such as termination of contract or employment, nor may they be disciplined or discriminated against in any manner including, but not limited to, demotion, shift change, pay cuts reduction in hours, room change, service reduction or in any other manner without justifiable reason. An employee who believes they ve been retaliated against for making a report of abuse, neglect or exploitation to should contact the New Mexico Department of Labor, Workforce Solutions office at (505) and file a complaint

33 DHI/: WHO WE ARE & WHAT WE DO MISSION exists to assure the health, safety, and well-being of individuals served on the DD waiver by investigating allegations of abuse, neglect, exploitation, suspicious injury, environmental hazard, and death. WHAT HAPPENS WHEN I REPORT AN INCIDENT/ALLEGATION? When you call the DHI Hotline, you will speak to a DHI/ Intake / On-Call staff. It is important to provide all of the information that you know about the incident/allegation, including the names and contact information for consumers, staff or other witnesses who were present or who have information about what happened. The on-call staff may ask additional questions so that they can have the most complete picture possible of what happened. A complete picture is needed so they can assign an accurate priority level for the response. More serious reports may require that an investigator come to the consumer s home within a matter of hours. For example, in the case of a report of physical abuse, an investigator may come to the home to take photographs of injuries. For those reports where there is reason to believe a crime was committed, the on-call staff will make sure that law enforcement was contacted. intake staff will evaluate (also called screen) the report they have received along with the necessary documentation about the consumer including incident reports, MERPs, CARMPs, ISPs etc. and decide two things. First, whether DHI/ has jurisdiction over the consumer. Second, whether the report/allegation meets the NMAC definitions for which they have authority to investigate, based on the reported circumstances. If these two requirements are met, the report/allegation will be assigned for investigation. If the report is not assigned (also referred to as screened out), or the allegation is substantiated, may refer you or the report to another appropriate agency

34 intake has 24 hours to evaluate/screen incidents that are reported. At times intake staff is unable to gather the necessary information within 24 hours to determine whether the individual s specific needs (as outlined in MERP, CARMP, ISP, etc.) impact the disposition/determination for potential abuse, neglect, or exploitation. This can occur when a provider is not timely in their provision of the requested information, or when the information is requested of an entity over which DHI has no authority (e.g., hospital records, police reports). When this occurs, implements its Intake Extension Request Policy procedures. This policy sets forth procedures to request additional time to collect and review information necessary in making a determination of the disposition of the reported incident/allegation. PRIORITY LEVELS FOR ASSIGNED INVESTIGATIONS has established revised response times related to investigations that are opened. Each opened investigation will be assigned a severity/priority rating that will determine the amount of time in which an investigator is to initiate the investigation: Emergency Case: Reports of very serious cases of abuse or neglect resulting in physical harm, including sexual abuse, or mental anguish which leave affected consumers at continued risk for injury or harm. Due to the severity of the case the investigator will respond within three (3) hours. Emergency Allegations include but are not limited to: Serious injuries fractures, head injuries, lacerations requiring sutures, serious burns, internal injuries Lack of medications for the health and safety of the individual. Sexual abuse where there is danger of repeated abuse Severe lack of basic physical necessities that could result in dehydration or starvation Need for immediate medical attention to treat conditions that could result in irreversible physical harm severe respiratory distress, unconsciousness, gangrene, advanced bedsores No caregiver is available and the consumer is unable to perform critical personal care activities Priority 1 Case: Reports of urgent cases of abuse, neglect or exploitation. Due to the severity of the case the investigator will respond within twenty-four (24) hours, but does not require more immediate action. Priority 1 allegations include but are not limited to: Falling or being pushed, hit or scratched which is alleged to have resulted in bruises or other injuries or severe mental anguish